UTSouthwestern said:
The going rate for private insurance ED's is high here in Dallas. That would probably explain why there are at least 4 dedicated OB groups that I know of in town, two of which reportedly pull in >$600K a year and haven't hired in 4+ years.
One of my OR nurses complained that for her delivery she was charged $2,800 for her epidural of which insurance covered $2,100, all to the anesthesia group. Ancillary charges for the ED kit, drugs, etc., added up to another $400.
One of the big Dallas hospital's medical director who is an OB-Gyn commented after receiving a bill for an epidural that was inadvertently sent to him instead of his patient that he charges the same amount for a year's worth of clinic visits and availability as the anesthesiologist who spent 10 minutes putting in an epidural and monitored it for 2 hours until delivery.
gaspimp, reimbursement is a bit too lengthy of a topic to discuss today, but I have a previous post in my profile that addresses it. You can do a search for it there. It varies widely by group.
Thats really wild, UT. Are the groups out of network or something with all the insurance companies or something?
And yeah, reimbursement is beyond a lengthy topic. To be very honest, I still don't understand it all. We had a fantastic office manager in my previous group that handled everything and she would report to us what was billed, what was collected, etc. Every once in a while we would talk about unit price, etc.
One thing that alot of residents/med students don't know yet is that YOU USUALLY DONT GET WHAT YOU BILL FOR.
😱
This isnt just in anesthesia, this is all doctors.
Lets say your hospital has a contract with Blue Cross Blue Shield. That means you'll be the provider in the surrounding area for Blue Cross pts. Whats bad is the insurance company will offer your group a certain percentage of your fees, not the whole amount.
Lets say your group is not a Blue Cross provider. Then the patient has to pay "out of network" fees, which is essentially what you are charging per unit. Of course this doesnt happen much- most people (you and me included) will go to the designated "in network" hospital/doctors because of the lower prices. Thats why I asked UT above if those OB groups were out of network.
Reimbursement is a game in its own. An anesthesia group (or an ortho group, ENT group, etc) has to have highly skilled people in their billing office because insurance companies are deft at figuring out ways not to pay you. If patients knew how hard doctors (actually doctor's business employees) have to work to get paid for work they've already done, they would flip out. Its ridiculous, anger producing bullsh*t. They will kick back the claim for ANYTHING- any little miniscule detail (times not totaled, signature missing, etc). And even when the claims are perfect they sometimes take their sweet time paying. More than once we had to hire a lawyer to add a little muscle, trying to get paid on an insurance companies backlog of over $100,000.
Know who paid us the best? THe prison system, our states organ procurement program, and workmans comp.
Maybe military MD can chime in- sounds like he's well versed in reimbursement.
